Abstract
Even though several SARS-CoV-2 vaccines have shown high effectiveness in the prevention of COVID-19 in healthy subjects, vaccination response in patients with plasma-cell-related disorders (PCD) remains widely unknown. Here, we report on an analysis describing the serological response after prime-boost SARS-CoV-2 vaccination in PCD patients, as compared to a healthy control group, and on possible influencing factors of serological responses. Blood samples were analyzed for the presence of quantitative anti-SARS-CoV-2 spike RBD Ig. A total of 82 patients were included; 67 received mRNA-, eight vector-based and four heterologous vaccinations. SARS-CoV-2 antibody titers (SP-AbT) were assessed in a mean of 23 days (SD ± 11 days) after the first and in a mean 21 days (SD ± 9) after prime-boost vaccination. A positive SP-AbT was detected in 31.9% of PCD patients after the first vaccination, and in 88.9% (44/49) after prime-boost vaccination, which was significantly less likely than that in the control group (100%, 78/78) (p = 0.008). Furthermore, we have been able to validate our previously suggested threshold of 30 CD19+ B lymphocytes/µL as being predictive for SP-AbT development. Despite anti-CD38 directed therapy, quadruplet treatment, higher age and missing deep remission, which correlated negatively with SP-AbT appearance, SP-AbT formation is possible in a majority of myeloma patients after prime-boost vaccination.
Highlights
Aged 18 years and older; Had a confirmed diagnosis of MM, smoldering MM, monoclonal gammopathy of clinical significance (MGCS) and systematic light chain amyloidosis (AL) according to the 2014 updated diagnostic criteria of the International Myeloma Working Group (IMWG) [24]; Were eligible for anti-SARS-CoV-2 vaccination according to international myeloma society (IMS) recommendations [24,25]; Provided written informed consent
Thirteen patients (15.9%) received quadruplet treatment consisting of a combination of daratumumab, bortezomib, thalidomide and dexamethasone (DaraVTd); isatuximab, carfilzomib, lenalidomide and dexamethasone (IsaKRd); or elotuzumab, pomalidomide, cyclophosphamide and dexamethasone (Elo-PCd)
Even though several in SARS-CoV-2 vaccines shown response high effectiveness in the preprevention of COVID-19 healthy subjects, the have vaccination and its mediated provention of COVID-19 in healthy subjects, the vaccination response and its mediated protection against SARS-CoV-2 infection in patients with MM and other plasma-cell-related disorders (PCD) remains widely tection against infection in patients
Summary
The global impact of the current COVID-19 pandemic has led to an impressively rapid development and approval of multiple SARS-CoV-2 vaccines, which showed both a high efficacy in the prevention of COVID-19 and the reduction of disease severity in case of a breakthrough infection in healthy subjects [1,2,3,4]. Several trials have demonstrated significantly lower vaccine-induced seroconversion rates in patients with hematological malignancies when compared to solid cancer patients or healthy control groups [5,6]. Focusing on multiple myeloma (MM) patients, infections, in general, and COVID-19, in particular, pose a major threat due to plasma-cell-dysfunction-related immunodeficiency, based on suppression of CD19+ B lymphocytes, lower levels of polyclonal immunoglobulins, and both quantitative and functional T-cell abnormalities [7,8,9,10,11]. A large retrospective analysis by the international myeloma society (IMS)
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